Assessment of All-Cause Cancer Incidence Among Individuals With Preeclampsia or Eclampsia During First Pregnancy

Chris Serrand (1, 2) , Thibault Mura (1, 2) , Pascale Fabbro (1, 3) , Gilles Seni (4, 2) , Ève Mousty (4, 2) , Thierry Boudemaghe (3, 4) , Jean-Christophe Gris (4, 3, 5)

1 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
2 UM - Université de Montpellier
3 IDESP - Institut Desbrest de santé publique
4 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
5 Sechenov First Moscow State Medical University

Importance: Preeclampsia or eclampsia (preeclampsia/eclampsia) during pregnancy induces major physiological changes and may be associated with specific cancer occurrences in later life. The current data regarding the association between preeclampsia/eclampsia and cancer are heterogeneous, and cancer risk after preeclampsia/eclampsia could be different depending on the organ. These uncertainties warrant reexamination of the association between preeclampsia/eclampsia and the risk of cancer overall and by specific cancer type. Objective: To evaluate the risk of cancer, overall and by type, after preeclampsia/eclampsia during a first pregnancy. Design, setting, and participants: This retrospective cohort study used data from the French hospital discharge database to identify all female individuals who had a pregnancy-associated hospitalization between January 1, 2010, and December 31, 2019. To allow a minimum of 2 years for the detection of medical history, individuals with a first detected pregnancy before January 1, 2012, were excluded, as were those with a cancer-associated hospitalization before or during their first detected pregnancy. Exposures, comorbidities, and occurrences of cancer were evaluated using data from the medico-administrative registers of hospitalizations in private and public French hospitals. Cox proportional hazards models were used to analyze cancer risk according to the occurrence of preeclampsia/eclampsia during first pregnancy. Exposures: Preeclampsia/eclampsia-associated hospitalization during the first detected pregnancy. Main outcomes and measures: The primary outcome was the incidence of cancer, including myelodysplastic or myeloproliferative diseases, after a first pregnancy with and without preeclampsia/eclampsia. Results: After exclusions, a total of 4 322 970 female individuals (mean [SD] age at first detected pregnancy, 29.6 [6.2] years) with and without preeclampsia/eclampsia during their first pregnancy were included. Of those, 45 523 individuals (1.1%) were diagnosed with preeclampsia/eclampsia during their first detected pregnancy. The maximum follow-up was 8 years, during which 29 173 individuals (0.7%) were diagnosed with cancer. No significant difference in overall cancer incidence was found between those with and without preeclampsia/eclampsia during their first pregnancy (adjusted hazard ratio [AHR], 0.94; 95% CI, 0.84-1.05). Preeclampsia/eclampsia was associated with an increase in the risk of myelodysplastic syndromes or myeloproliferative diseases (AHR, 2.43; 95% CI, 1.46-4.06) and kidney cancer (AHR, 2.19; 95% CI, 1.09-4.42) and a decrease in the risk of breast cancer (AHR, 0.79; 95% CI, 0.62-0.99) and cervical cancer (AHR, 0.75; 95% CI, 0.58-0.96). Conclusions and relevance: In this study, a history of preeclampsia/eclampsia during first pregnancy was associated with an increase in the incidence of myelodysplastic or myeloproliferative diseases and kidney cancer and a decrease in the incidence of cervical and breast cancers. These associations might reflect an underlying common factor among preeclampsia/eclampsia and these pathologies and/or an association between preeclampsia/eclampsia and the development of these cancers.

Domaines: Hématologie; Gynécologie et obstétrique

Chris Serrand, Thibault Mura, Pascale Fabbro, Gilles Seni, Ève Mousty, et al.. Assessment of All-Cause Cancer Incidence Among Individuals With Preeclampsia or Eclampsia During First Pregnancy. JAMA Network Open, 2021, 4 (6), pp.e2114486. ⟨10.1001/jamanetworkopen.2021.14486⟩. ⟨hal-03701585⟩